There is a clear pattern in complaints about psychiatrists. Patients say they routinely experience inconsistent care and receive contradictory advice. Some describe an apathy that borders on box-checking.
“There were 14 locums. [and] They all had different views and opinions about my treatment,” said one respondent to a survey of 469 patients by advocacy group Vox Scotland. “My last visitor didn’t bother to call me back. That was four months ago. I haven’t heard from the mental health team since.”
vox scotland We investigated patients after hearing repeated cases of poor experiences with locums, the psychiatrists on whom Scotland’s mental health services increasingly rely.
Some people’s anger is visible. “It’s a crime that there is no regard for people or for the system and what they have been allowed to do, especially in the last few years, by moving everything online,” one respondent said. “Many neurodivergent people like me don’t have access to online appointments. Suicidal? There’s nothing more in need of care than a 5-minute Zoom and someone 20 miles away to pick up your prescription.” .”
Vox respondents gave evidence about their experiences across all 14 of Scotland’s health boards, which have spent £134m on psychiatrists since 2019.
Almost a third said all or most of their care came from locums, and half of them were dissatisfied or very dissatisfied with the overall quality of care. A fifth of those surveyed said they did not know whether they were seeing a locum or NHS psychiatrist.
“A new place always has new ideas and medicines change, but you never stay long enough to see if the medicines work or not, and a new cycle begins,” said another.
“Every time you see someone different, you have to pour out your heart and soul,” said another. “For vulnerable people, there is no connection or relationship with a community psychiatrist. You can’t do that just because you got a note from the last person.”
These findings are currently being collated by Vox for a report due to be published this year, raising concerns among senior psychiatrists that the system is in crisis. Spending on mental health has been reduced even as overall health spending has increased. Over the past five years, the number of NHS psychiatrists in Scotland has fallen by 17% (130 people), to 651 full-time posts.
Dr Amanda Cotton, spokesperson for the Psychiatric Senior Care Managers Group, said NHS staff were working “increasingly to continue to provide the services people expect, but cracks are definitely starting to appear. I don’t think it’s an exaggeration,” he said. show”.
Dr Jane Morris, Scottish president of the Royal College of Psychiatrists, believes this trend poses very difficult questions. “I don’t want to be a fearmonger, but we can also think of ourselves as an NHS that exists purely to buy professionals from locum agencies,” she said.
“Not only would it be a very expensive use of taxpayers’ money, but we would lose a lot of the checks and balances, quality assurance and that kind of sense of belonging. It’s an emotional pull. We want to continue to strive for that. People still want to be stuck in it, but it’s never too late to do it again. I think so.”
